Healthcare Provider Details

I. General information

NPI: 1700305679
Provider Name (Legal Business Name): HORIZON MEDICAL TREATMENT CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 BLUEBONNET BLVD STE B
BATON ROUGE LA
70809-9679
US

IV. Provider business mailing address

4313 BLUEBONNET BLVD STE B
BATON ROUGE LA
70809-9679
US

V. Phone/Fax

Practice location:
  • Phone: 225-636-2910
  • Fax: 225-636-5227
Mailing address:
  • Phone: 225-636-2910
  • Fax: 225-636-5227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number304510
License Number StateLA

VIII. Authorized Official

Name: STEPHEN COVINGTON GUILBAULT
Title or Position: OWNER/ ADMIN DIRECTOR
Credential:
Phone: 225-636-2910